Effects of Social Distancing During the COVID-19 Pandemic on Anxiety and Eating Behavior-A Longitudinal Study - Frontiers
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BRIEF RESEARCH REPORT
published: 01 June 2021
doi: 10.3389/fpsyg.2021.645754
Effects of Social Distancing During
the COVID-19 Pandemic on Anxiety
and Eating Behavior—A Longitudinal
Study
Fernanda da Fonseca Freitas 1,2 , Anna Cecília Queiroz de Medeiros 2 and
Fívia de Araújo Lopes 1,3*
1
Post-Graduate Program in Psychobiology, Department of Physiology and Behavior, Federal University of Rio Grande do
Norte, Natal, Brazil, 2 Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil,
3
Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
As social animals, humans need to live in groups. This contact with conspecifics
is essential for their evolution and survival. Among the recommendations to reduce
transmission of the new coronavirus (SARS-CoV-2) responsible for COVID-19 are social
distancing and home confinement. These measures may negatively affect the social life
Edited by: and, consequently, the emotional state and eating behavior of individuals. We assessed
Marco Antonio Correa Varella,
the impact of the COVID-19 pandemic on the anxiety, premenstrual symptoms,
University of São Paulo, Brazil
and eating behavior of young women. Data collection was conducted in person
Reviewed by:
Hamdi Chtourou, (prepandemic—from March to December 2019) and online (during the pandemic—
University of Sfax, Tunisia August 2020). A total of 71 participants, average age of 21.26 years (SD = 0.41), took
Naiara Ozamiz,
University of the Basque Country, part in the study. Trait anxiety during the pandemic was significantly lower than in the
Spain prepandemic period. Investigation of the “anxiety/stress” symptom of the Premenstrual
Laisa Liane Paineiras-Domingos,
Symptoms Screening Tool (PSST) revealed that this symptom was more severe before
Federal University of Bahia, Brazil
the pandemic. There was a decline in the desire for sweet and fatty foods during the
*Correspondence:
Fívia de Araújo Lopes pandemic. However, craving for traditional foods rose significantly in the same period.
fivialopes@gmail.com Uncontrolled and emotional eating were significantly lower during the pandemic. The
Specialty section:
results suggest that the pandemic may have had a positive impact on anxiety and
This article was submitted to eating behavior of the participants, which may be due to differences between urban and
Health Psychology, rural populations and the latter living with their families. These findings are important for
a section of the journal
Frontiers in Psychology raising a discussion regarding the effects of the current environment on the regulation of
Received: 04 January 2021 cognitive and dietary adaptations.
Accepted: 19 April 2021
Keywords: COVID-19, social isolation, confinement, dietary behavior, mental health, human evolution
Published: 01 June 2021
Citation:
Freitas FF, de Medeiros ACQ and
Lopes FA (2021) Effects of Social
INTRODUCTION
Distancing During the COVID-19
Pandemic on Anxiety and Eating
As social animals, human beings benefit from contact with co-specifics, since living in a group is an
Behavior—A Longitudinal Study. important strategy used by our ancestors to overcome daily challenges, which resulted in cognitive
Front. Psychol. 12:645754. adaptations that support sociability (Dunbar, 2008, 2020; Lopes et al., 2018). Once basic needs are
doi: 10.3389/fpsyg.2021.645754 met, a more significant factor for the subjective and emotional well-being of most people seems to
Frontiers in Psychology | www.frontiersin.org 1 June 2021 | Volume 12 | Article 645754
Freitas et al. Social Distancing, Anxiety, and Eating Behavior
be good relationships with friends and family. In addition, hormonal variations that occur during the menstrual cycle, more
the size and quality of a person’s social network also specifically, the decline in estrogen and increase in progesterone
have a positive influence on mental health (Dunbar, 2017; that take place in the luteal phase or premenstrual period, may
Kenrick and Krems, 2018). affect brain function, cognitive processes, emotional state, and
Similar to how our species evolved to live in groups, another appetite, among others. The symptoms associated with this phase
clearly important psychological mechanism is activated in this can be variable or inconstant and generally include the following
context. The risk of dying from a contagious disease was a real emotional signs: anger, irritability, anxiety, lack of concentration,
and significant threat to our ancestors. However, a behavioral and changes in mood and eating behavior (Johnson et al., 1995;
immune system, that is, a set of specific behaviors, may help Nissar et al., 2008).
us avoid diseases (Schaller and Park, 2011; Griskevicius and Concerning the last point, stress and anxiety caused by social
Kenrick, 2013; Ackerman et al., 2020). SARS-CoV-2 is a new distancing, home confinement, the routine acquired during the
coronavirus responsible for coronavirus disease 2019 (COVID- pandemic, and partial or total loss of income (De Backer et al.,
19) (Parlapani et al., 2020). In order to reduce virus transmission, 2021) may also influence eating behavior, having a negative effect
social distancing and home confinement were recommended on the amount and quality of the food consumed and access to it
by health authorities and governments (Lakhan et al., 2020; (Ammar et al., 2020; Cherikh et al., 2020; Górnicka et al., 2020;
Parlapani et al., 2020; Tang et al., 2020). However, distancing Naja and Hamadeh, 2020; Cummings et al., 2021). However,
measures, even when added to activation of this behavioral the psychological suffering caused by COVID-19 can also be
immune system, may have a negative effect on the social life and related to positive eating behavior, as preparing food potentially
emotional state of individuals (Ackerman et al., 2020; Akdeniz works as an activity to relieve stress (Mosko and Delach, 2020;
et al., 2020; Cornine, 2020; Di Renzo et al., 2020; Ingram et al., De Backer et al., 2021).
2020; Shigemura et al., 2020; Volino-Souza et al., 2020; Wang Many characteristics acquired by human beings through
et al., 2020; Zhou et al., 2020). natural selection have reflected on dietary quality. Selective
Thus, in addition to the protective recommendations against pressure has resulted in the foods obtained being composed of
COVID-19, the fear of contracting the virus, and subsequently essential nutrients able to rapidly meet their nutritional needs.
dying from it, uncertainty about disease control and vaccine However, despite the maintenance of adaptive predispositions,
availability, daily routine interruptions, economic loss, and over time, the reason for food intake was no longer exclusively
constant exposure to negative news are factors considered highly to meet nutritional needs because current life conditions (such
responsible for the surge in mental health problems, such as as the development of a series of diseases) have emerged
anxiety (Akdeniz et al., 2020; Cornine, 2020; Di Renzo et al., 2020; (Zucoloto, 2011; Lopes et al., 2018; Nettersheim et al., 2018;
Ingram et al., 2020; Kang et al., 2020; Ozamiz-Etxebarria et al., Rantala et al., 2019).
2020; Shigemura et al., 2020; Volino-Souza et al., 2020; Wang Current life conditions that have a negative effect on mental
et al., 2020; Zhou et al., 2020). In university students, anxiety health, causing stress and anxiety, can also be responsible for
symptoms have also been caused by concern about delays in dietary changes (Ammar et al., 2020). In order to regulate
academic activities and future job prospects (Akdeniz et al., 2020; and reduce negative emotions, these situations are generally
Cornine, 2020; Zhou et al., 2020). associated with unhealthy foods, since due to the interaction
In principle, anxiety is a response that arises naturally as between some foods and the central reward pathways, there
individuals are exposed to some everyday situations, serving as is a propensity to desiring and consuming “tasty” foods with
preparation for future events (Nesse, 2019a). However, when the high levels of sugar, fat, and calories (Wardle et al., 2000;
response to these situations is no longer adequate (adaptive), Sominsky and Spencer, 2014; Ingram et al., 2020). In line with
anxiety can be pathological and present itself as a mental this information, some research has observed an increase in
disorder, known as anxiety disorder. What differentiates adaptive total caloric intake (Ismail et al., 2020) and in candy intake
anxiety from anxiety disorders are fear, emotional reaction, (Deschasaux-Tanguy et al., 2020; Górnicka et al., 2020; Ismail
and excessive behavioral disturbances, which exist without et al., 2020; Cummings et al., 2021) during home confinement
adequate or proportional external stimulation to explain them caused by COVID-19. However, Rodríguez-Pérez et al. (2020)
and generally persist beyond the periods considered appropriate described that home confinement promoted a low intake of
(Braga et al., 2010; American Psychiatric Association, 2014). sweets by the participants in their study.
From an evolutionary point of view, it is necessary to consider In studies on eating behavior, the term food craving has been
that the demands of the current environment differ enormously used to describe an “intense desire to eat a certain type of food”
from those in which the set of human development adaptations (Rogers and Smit, 2000) and is more associated with eating
was selected. Thus, it is possible that an incompatibility between foods with high sugar content. The foundation for the strong
the evolved adaptation and the current environment favors preferences that many animals have for sweet foods results from
the occurrence of these mental disorders, that is, the current their need to identify sources of metabolic fuel, especially glucose.
environment does not drive the evolved mechanism in the way In this respect, energy that is more readily available in food
predicted (Kennair, 2003). containing glucose would allow the brain to react to signals and
With respect to anxiety in women, in addition to the symptoms caused by anxiety. However, the degree of sweetness
possible changes caused by the pandemic, the menstrual cycle does not provide quantitative information on glucose content,
also influences neurological and psychological functions. The that is, energy (Beauchamp, 2016). Thus, the primary function
Frontiers in Psychology | www.frontiersin.org 2 June 2021 | Volume 12 | Article 645754
Freitas et al. Social Distancing, Anxiety, and Eating Behavior
of preference for sweets may lie in the flavor of these foods, Norte (Protocol number CASE: 91161718.0.0000.5568; Research
since the sensation of sweetness is generally associated with a authorization: 2.830.540).
pleasant experience or reward, not necessarily proportional to Included were volunteers aged 18 years and older who
the glucose content present in the food (Beulens et al., 2004; gave written informed consent to participate. Students using
Beauchamp, 2016). anxiolytics or antidepressants (including natural) were excluded
It is noteworthy that in ancestral environments, sweet from the study. The in-person stage, which occurred from
flavors were associated with fruits, yams, and honey. Thus, the March to December 2019 (prepandemic period), included
preference and ingestion of foods considered sweet were not 136 participants, who responded to five questionnaires:
considered harmful to health. In this perspective, the sweet foods sociodemographic, Brazilian Food Craving Inventory (FCI-Br),
currently desired by humans can be considered evolutionarily the Brazilian version of the Three Factor Eating Questionnaire—
incompatible, as they are produced with large amounts of R21 (TFEQ-R21), State Trait Anxiety Inventory (STAI), and
processed sugars and lacking nutrients, and the physiological the Brazilian version of the Premenstrual Symptoms Screening
mechanisms that involve insulin and glucagon have not evolved Tool (PSST). In the online stage, conducted in August 2020
to repeatedly metabolize abnormally large amounts of sugar (during the pandemic), 5 months after the implementation of
(Li et al., 2018). confinement measures in Rio Grande do Norte state (RN), 71
This trend to eat certain foods, excessively or not, which students responded online to the same questionnaires applied
manifests itself as a response to some emotional states, is called in the first stage, adding whether they had been diagnosed
emotional eating behavior or emotional eating (Ouwens et al., with COVID-19 and answering a question related to home
2009; Serin and Koç, 2020). Considering anxiety during the confinement (Figure 1).
premenstrual period and its relation with eating patterns, the
preference/desire and increase in sweet food consumption that Measures and Instruments
occur during this time (Gingnell et al., 2012) may be related to an Nutritional Status Assessment
attempt to modulate anxiety as a symptom attributed to the luteal Prepandemic nutritional status was assessed using body mass
phase of the menstrual cycle (Bernardi et al., 2005). In addition, index (BMI), which was calculated from the weight and
from an evolutionary perspective, the desire and intake of caloric height self-reported by the participants in the sociodemographic
foods in the premenstrual period (reflecting proximal aspects, questionnaire [validation of BMI from self-reported measures, in
according to Tinbergen, 1963; Nesse, 2019b) may be due to the this population, was performed in the study of Lima et al. (2018)].
increased metabolic expense to prepare the body for reproduction
(distal aspects— Tinbergen, 1963; Nesse, 2019b). The metabolic Assessment of Eating Behavior
rate in the follicular phase is approximately 7% lower than in the The FCI-Br and the Brazilian version of the TFEQ-R21 were used
luteal phase of the menstrual cycle (Strassmann, 1999). to assess eating behavior. The FCI-Br was validated by Medeiros
In light of the above, the aim of the present study was to assess et al. (2017) and was created based on the Food Craving Inventory
the impact of the pandemic caused by COVID-19 on anxiety, (White et al., 2002), which categorizes and identifies foods that
premenstrual symptoms, and eating behavior in young women. are most related to craving, investigating the frequency of these
Our expectation was that the pandemic was related to an increase episodes in the previous month. The FCI-Br consists of 23 foods
in the levels of anxiety and premenstrual symptoms and that it commonly related to craving, divided into three categories: high
had an impact on eating behavior, intensifying emotional eating fat content (pizza, fried pastry, bacon, salty packaged snacks,
and the craving for certain foods, especially sweets. lasagna, sandwich/hamburger, coxinha, and French fries), sweets
(cookies; dulce de leche; chocolate; condensed milk pudding;
candy such as hard candy, lollipop, and jelly beans; ice cream;
brigadeiro; sweet pie; and cake), and traditional foods (bread,
MATERIALS AND METHODS barbecue/grilled meat, farofa, cheese, beans/feijoada, and steak)
(Medeiros et al., 2016a; Meule, 2020).
Participants and Procedures The TFEQ was developed by Stunkard and Messick (1985)
The sample was composed of university students from rural to determine cognitive restraint (CR), disinhibition, and
Rio Grande do Norte state (RN), northeastern Brazil. The study susceptibility to hunger in adults. The first version of the TFEQ
occurred in two stages, one in person and one online. During consisted of 51 items, but later studies developed shorter and
the first stage, volunteers were recruited through personal contact psychometrically improved versions of this questionnaire, such
and advertising the study on posters, in classrooms, and other as the TFEQ-R21. The shorter TFEQ-R21 version, adapted and
common areas of the university. The second stage was conducted translated to Brazilian Portuguese by Medeiros et al. (2016b),
on the internet using the Google Forms platform and the was created based on the TFEQ-51, containing 21 items and
link was shared through WhatsApp and by email (according assessing three eating behavior dimensions: emotional eating
to information reported by the participants in the first stage). (EA), uncontrolled eating (UE), and CR. The EA scale measures
The study is in accordance with Brazilian National Health the susceptibility of consuming foods as a response to emotional
Council and the Declaration of Helsinki and was approved stress and negative mood states. UE behavior is the tendency
by the Research Ethics Committee for the Faculty of Health to lose control overeating when feeling hungry or exposed to
Sciences of Trairi of the Federal University of Rio Grande do external stimuli (for example very tasty food), even in the absence
Frontiers in Psychology | www.frontiersin.org 3 June 2021 | Volume 12 | Article 645754Freitas et al. Social Distancing, Anxiety, and Eating Behavior
FIGURE 1 | Diagram for the participants’ recruitment and inclusion in the study.
of hunger. Finally, CR is characterized as the limitation (cognitive II is composed of five items that assess the functional impact of
and self-imposed) of food ingestion in order to control body PMS. Each item is answered according to a four-point Likert scale
weight (Medeiros et al., 2016b, 2019). (0 = absent; 1 = mild; 2 = moderate; 3 = severe) (Steiner et al.,
2003; Henz et al., 2018).
Assessment of Anxiety
The State-Trait Anxiety Inventory (STAI) was used to assess Assessment of Home Confinement
anxiety. The STAI was developed by Spielberger et al. (1970) and The participants answered a question about how much people
translated and adapted for Brazil by Biaggio and Natalício (1979). were leaving home (for any purpose) during confinement, using
The tool is used to assess relatively stable anxiety. It consists of a five-point Likert scale (0 = much less than usual; 1 = less than
20 statements concerning personal feelings, where the subjects usual; 2 = the same, no change; 3 = more than usual; 4 = much
report on the frequency at which these feelings generally occur. more than usual).
Each statement is answered on a scale varying from 1 (almost
never) to 4 points (almost always), and each volunteer obtained Data Analysis
scores between 20 and 80 (Spielberger et al., 1970; Vigneau and Data normality and homogeneity were verified by the
Cormier, 2008; Leal et al., 2017). Kolmogorov–Smirnov and Shapiro–Wilk tests, respectively.
Normally distributed variables were compared using the paired
Assessment of Premenstrual Symptoms Student’s t-test, and for the others, the Wilcoxon signed rank test
Premenstrual symptoms were assessed using the Brazilian version was used. The relation between variables was determined by the
of the PSST. The PSST was developed and validated for Brazil chi-squared test. The results were considered significant at a 95%
by Câmara et al. (2016). This instrument identifies the presence significance level (p < 0.05).
of premenstrual symptoms (PMS) and premenstrual dysphoric
disorder (PMDD) and is composed of 19 items subdivided into
two domains. Domain I consists of 14 physical and psychological RESULTS
manifestations of PMDD described in the diagnostic and
statistical manual of mental disorders (DSM-IV). Among the A total of 71 subjects, with an average age of 21.26 years
symptoms assessed in this domain is “anxiety/stress.” Domain (SD = 0.41) and mean prepandemic BMI of 22.93 kg/m2
Frontiers in Psychology | www.frontiersin.org 4 June 2021 | Volume 12 | Article 645754Freitas et al. Social Distancing, Anxiety, and Eating Behavior
FIGURE 2 | Result of the main measures observed in the study. (A) Trait anxiety before and during the pandemic. (B) Food craving before and during the pandemic.
(C) Dimensions of eating behavior before and during the pandemic. (D) Premenstrual symptoms by domain and total before and during the pandemic. PSST,
Premenstrual Symptoms Screening Tool; DI, domain I from PSST; DII, domain II from PSST; ∗ p < 0.05.
(SD = 0.44), indicating a predominance of eutrophic nutritional versus 21.0 (18.0–27.0), z = −3.776, p < 0.001, r = 0.45, n = 71].
status in the evaluated group (88.7% of participants), took The craving for traditional foods rose significantly in the same
part in the study. Three of the students (4.3%) had been period [14.0 (10.0–17.5) versus 17.0 (13.0–19.5), z = −3.203,
infected by COVID-19. p = 0.001, r = 0.38, n = 71] (Figure 2B).
In relation to the three dimensions of eating behavior assessed
Anxiety by TFEQ-R21, uncontrolled [56.0 (47.0–68.0) versus 50.0 (42.0–
With respect to anxiety, the STAI revealed that trait anxiety 62.5), z = −2.771, p = 0.006, r = 0.33, n = 71] and emotional eating
during the pandemic (44.4 ± 8.4 points) was significantly [67.0 (46.0–79.0) versus 58.0 (42.0–75.0), z = −2.229, p = 0.026,
lower [t(70) = 2.023, p = 0.047, r = 0.23, n = 71] than in r = 0.26, n = 71] were significantly lower during the pandemic.
the prepandemic period (46.4 ± 8.7 points) (Figure 2A). It is Cognitive restraint increased during this time, but the difference
important to underscore, reinforcing the stability of the measure, was not significant (Figure 2C).
that the score remained classified as moderate anxiety despite the
significant difference. Actions During the Pandemic
The total PSST score showed no change in the presence and In relation to “outings during social distancing,” 49 (69.0%) of the
severity of premenstrual symptoms between the two periods participants left their home “much less than usual,” 21 (29.6%)
analyzed [t(70) = −0.013, p = 0.990, n = 71] (Figure 2D). “less than usual,” and 1 (1.4%) “more than usual.”
However, the “anxiety/stress” symptoms of this tool revealed As shown in Figure 3, when analyzed separately, differences
that it was more severe in the students before the pandemic were identified between the prepandemic and pandemic period
[χ2 (2) = 8.884, p = 0.012, Table 1]. only in the group that left their home “much less than usual,”
which demonstrated a decline in craving for sweet foods [26.0
Eating Behavior (22.0–33.0) versus 21.0 (19.0–29.0), z = −3.616, p < 0.001,
Considering food craving, there was a significant decline in the r = 0.52, n = 49] and uncontrolled [58.0 (50.0–69.0) versus 50.0
desire for sweet foods during the pandemic [25.0 (20.5–31.5) (44.0–61.0), z = −2763, p = 0.006, r = 0.39, n = 49] and emotional
Frontiers in Psychology | www.frontiersin.org 5 June 2021 | Volume 12 | Article 645754Freitas et al. Social Distancing, Anxiety, and Eating Behavior
eating [67.0 (50.0–79.0) versus 58.0 (46.0–75.0), z = −1.982, fewer temptations to eat harmful foods (Ingram et al., 2020;
p = 0.047, r = 0.28, n = 49], as well as an increase in craving López-Bueno et al., 2020; Rodríguez-Pérez et al., 2020).
for traditional foods [26.0 (22.0–33.0) versus 21.0 (19.0–29.0), With respect to home confinement, our results corroborate
t(48) = −2.733, p = 0.009, r = 0.37, n = 49]. these explanations in that the participants who leave home
When the prepandemic and pandemic periods were “much less than usual” during the pandemic reported a decline
compared, no significant differences were found in terms of in craving for sweet foods, while craving for traditional foods
trait anxiety (Figure 3A), presence and severity of premenstrual increased, likely due to the greater exposure to this type of food.
symptoms (Figure 3B), “anxiety/stress” symptom, craving for In this respect, an electronic survey conducted in Poland
fatty foods, and food restraint. (PLifeCOVID-19) revealed that 48% of those interviewed
reported an increase in the consumption of home-cooked meals,
attributed to the increased possibility of preparing a meal at
DISCUSSION home or more free time to take care of health during home
confinement (Górnicka et al., 2020). Similarly, the COVIDiet
Stressful situations observed in contemporary environment may study (Rodríguez-Pérez et al., 2020) carried out with 7,514
be associated with the desire to eat foods with high sugar or Spanish adults showed that during COVID-19 confinement,
fat contents, since there is an attempt to attenuate psychological there was significant adherence to the Mediterranean diet
stress by consuming these foods (Rantala et al., 2019). In (characterized by the consumption of extra virgin olive oil, whole
this respect, the spread of the pandemic and the protective grains, and vegetables, with low intake of sweets, red meat, and
measures adopted, such as social isolation and distancing, would processed foods; Bach-Faig et al., 2011).
compromise mental health and lead to the intake of unhealthy Another cross-sectional online survey carried out in 38
foods (Wardle et al., 2000; Sominsky and Spencer, 2014; Ammar countries, which investigated three domains of food literacy
et al., 2020; Ingram et al., 2020). behavior (food planning, selection, and preparation), observed
Unlike the above-described expectation, the present study that during the COVID-19 pandemic, the perception of having
found that the anxiety trait remained moderate before and during more time was associated with increases in planning, selecting,
the pandemic and that the “anxiety/stress” symptom was milder and preparing healthier foods for women and men and that
during the pandemic. It also revealed a decrease in craving policies for staying at home or working at home were positively
for sweet foods and an increase for traditional foods during related to planning and preparing healthier foods for both sexes
the same period, in addition to a decline in uncontrolled and (De Backer et al., 2021).
emotional eating. On the other hand, an online survey on mental health
Pandemics cause concern and anxiety is a commonly observed and lifestyle during home confinement (ECLB-COVID19),
psychological problem in these situations. Reinforcing this fact, involving 35 research organizations from Europe, North
it was reported that in China (Wang et al., 2020), Spain Africa, Western Asia, and the Americas, found an unhealthy
(Ozamiz-Etxebarria et al., 2020), Japan (Shigemura et al., 2020), dietary pattern (type of food, uncontrolled eating, between-
Wuhan, and Scotland, COVID-19 caused mental problems in the meal snacks, and number of main meals) during home
population (Ingram et al., 2020). confinement (Ammar et al., 2020). Another study with 1,012
However, although the fear of contracting the virus participants from the United Arab Emirates showed a significant
is a continuous stressor that stimulates the appetite increase in the percentage of subjects that consumed primarily
and emotional eating mediated by glucocorticoids home-cooked meals, and that the foods selected were not
(Sominsky and Spencer, 2014), biological (Rantala et al., 2018), nutritious, with the daily presence of sweets and savory
sociocultural, economic, and environmental factors may affect snacks, which was also attributed to restricted food access
the mental health of individuals differently in stressful situations (Ismail et al., 2020).
(Liu et al., 2020). For example, confinement can produce healthier De Backer et al. (2021) also observed that staying at home
eating habits, due to the greater time available for cooking and was negatively associated with the selection of healthier
foods for women and men. In addition, another relevant
finding was a greater psychological distress observed in
TABLE 1 | Evaluation of anxiety/stress from the Premenstrual Symptoms women during the COVID-19 pandemic and that this
Screening Tool (PSST).
psychological distress was related to decreased planning,
Prepandemic During the pandemic selection, and preparation of healthier foods. Among men,
there was an increase in the preparation of healthier meals
n = 71 n = 71
when psychological suffering increased. This result can
Anxiety/stressa *
be explained by the possibility that, during the pandemic,
psychological suffering became a barrier to the daily
Absent and mild 18 (25.4%) 24 (33.8%) cooking of women, but for men, it was an alternative
Moderate 29 (40.8%) 38 (53.5%) to relieve stress.
Severe 24 (33.8%) 9 (12.7%) It is important to underscore a significant aspect of the
The results are expressed as n (%). a Extracted from domain I from the Premenstrual present study, namely that food intake was not measured, but
Symptoms Screening Tool. *p < 0.05 in Pearson’s chi-squared test. rather eating behavior. Particularly with respect to craving, the
Frontiers in Psychology | www.frontiersin.org 6 June 2021 | Volume 12 | Article 645754Freitas et al. Social Distancing, Anxiety, and Eating Behavior
FIGURE 3 | Comparison between the different measures obtained in the study, considering the confinement at home of participants during the pandemic. (A) Trait
anxiety according to confinement at home. (B) Premenstrual symptoms according to confinement at home. (C) Food craving according to confinement at home.
(D) Dimensions of eating behavior according to confinement at home. PSST, Premenstrual Symptoms Screening Tool; ∗ p < 0.05.
decrease and increase in craving for sweets and traditional foods, while 202 (31.7%) were in the moderate and 101 (15.8%) in
respectively, indicate a change in the desire to eat a certain type the high EE group. The study also demonstrated that eaters
of food, suggesting an intriguing perspective for the future eating with the highest EE score had a trend to report anxiety.
habits of these women. However, no significant association was observed between
In relation to the impact of the pandemic on dietary anxiety and EE. One possible explanation is that anxiety
behavior, 638 undergraduate and former undergraduate female provoked by COVID-19 was an acute stressor, thereby
students from King Saud University in Saudi Arabia were reducing appetite and emotional eating (Al-Musharaf,
studied. In this survey, approximately half the women in the 2020). It is important to emphasize that these reports
sample reported emotional eating (EE) during the COVID-19 were compiled over a short period of time after the onset
pandemic. A total of 335 women (52.5%) reported low EE, of the pandemic.
Frontiers in Psychology | www.frontiersin.org 7 June 2021 | Volume 12 | Article 645754Freitas et al. Social Distancing, Anxiety, and Eating Behavior
In the United States, the study by Cummings et al. (2021) problems associated with the COVID-19 pandemic in urban
demonstrated that during the COVID-19 pandemic, American individuals compared with those who live in rural environments
adults increased the addition of sugars to foods by 14%, but (Liu et al., 2020).
despite this increase in sugar intake, there was no increase in In addition to the reasons explained above, the higher
total food consumption in response to the stress caused by the incidence of mental health problems in individuals living
pandemic. So, the reason for this sharp change in eating behavior in urban environments may be due to an evolutionary
may be due to the purchase of more nonperishable processed incompatibility, as different from the ancestral world and small
foods during this period. cities, urban centers are marked by a greater dispersion of
Given these different results, a key factor to consider families, less exposure to nature, sleep disturbances, greater
is that the participants of the present study are university sedentary lifestyle, and greater intake of processed foods
students from a rural area of the state, but most come (Rantala et al., 2021). As societies globalize and human-
from small towns in the region and are only living in the induced environmental changes increase rapidly, evolutionary
city where the university is located for study purposes. mismatches are becoming increasingly prevalent (Li et al., 2018).
Living outside the family home has been a factor related to The protective measures implemented due to the COVID-
poor quality of diet and emotional and anxiety disorders 19 pandemic may have aggravated the practice of unhealthy
in undergraduate students (Papadaki et al., 2007; Zurita- lifestyles, such as physical inactivity and the consumption of
Ortega et al., 2018; Cao et al., 2020). Thus, despite the processed foods. In this sense, in addition to the stress and
protective measures and the concern about the new anxious symptoms caused by the incompatibility of biological
coronavirus, returning to their hometowns to be with and cognitive expectations between the ancestral and the
their families may explain the lower anxiety and eating contemporary environment of urban centers (Kavanagh and
behaviors observed. Kahl, 2018), the negative changes in mood can also be related
As humans are highly social animals, the response to the threat to neuroinflammation caused by current and evolutionarily new
of infection by COVID-19 causes the desire for contact and social lifestyles, as factors such as unhealthy eating and low or no
support, especially in relation to loved or vulnerable people, such physical activity favor the increase in the serum amount of
as family members (Dezecache et al., 2020). The loss of this type proinflammatory cytokines (Rantala et al., 2018, 2021).
of social contact can have an impact on subjective well-being The influence of returning to their families and the fact that
(Paredes et al., 2021), with a negative response from the nervous the study population live in small cities seem to be essential
system, since the activation of some psychological mechanisms to understanding the results of the present study, since they
in contexts of food sharing and other forms of cooperation so contradict other research, which found an increase in anxiety
important in the evolutionary history of our species is limited levels among university students in several countries (Akdeniz
(Ringer et al., 2019). et al., 2020; Cornine, 2020; Wang et al., 2020; Zhou et al.,
This influence seems to be supported by evidence from the 2020). In our study, we recorded a reduction in anxiety trait
Spanish study COVIDiet, which found that living at home expression. Although we are referring to a trait, and therefore,
with one’s family may be associated with a healthier diet with less expectation of change, Cohen et al. (2014) argue that
(Rodríguez-Pérez et al., 2020). A study with 7,143 Chinese it is possible that there are changes in the expression of a trait,
university students reported that living with families/parents especially when we consider the nature of the situations in
during the pandemic may be a protective factor against which the trait is expressed. Dealing with the pandemic situation
anxiety (Cao et al., 2020). In addition, it is believed that has been one of the greatest experiments that humanity has
people who frequently eat with others are happier and been facing. We still have no way of accurately measuring the
more satisfied with their lives, since eating socially releases psychological effects that such a situation can have in the short,
endorphins, which may promote the same positive effect medium, and long term.
as that caused by physical exercise (Cohen et al., 2010; This study has several limitations due to the following
Dunbar, 2017). factors: not investigating the economic situation and exposure
One aspect that deserves attention is the opportunity we to pandemic-related information of the participants; the data
had to observe the behavior of a group outside of large being self-reported, which may have introduced memory bias;
urban centers. A number of factors indicate that living in and the online stage having occurred at a time when some of
small cities may also protect individuals against stress and the social distancing measures had been relaxed (beginning of
anxiety. Most cases of COVID-19 occurred in the state capitals, the reopening of commercial stores and nonessential services).
resulting in greater sensitivity and vulnerability to psychosocial Nevertheless, the study exhibits strong points that produced
impacts of the pandemic on the residents of these communities. robust results. We compared data collected in the prepandemic
The high population densities of the capitals facilitate the and pandemic periods, and the sample was non-urban (less
transmission of the virus, producing stress due to the increased studied in other research) and composed of young women, who
perceived risk of infection. Moreover, living in large cities are more predisposed to developing mental disorders. Also, as
may also raise the likelihood of access to communication and a positive aspect, the study was carried out in a sample of the
information. A study performed with 3,068 subjects in China, Latin American population that was little studied. Most research
consisting of 1,928 urban dwellers and 1,140 rural residents, are conducted in North America or Western Europe (Henrich
reported a significantly higher prevalence of mental health et al., 2010). Thus, in order to obtain representativeness regarding
Frontiers in Psychology | www.frontiersin.org 8 June 2021 | Volume 12 | Article 645754Freitas et al. Social Distancing, Anxiety, and Eating Behavior
human species diversity, science needs to include more cultures ETHICS STATEMENT
(Barrett, 2020), focusing particularly on less studied populations.
Still, at a time when public policies for coping with COVID- The studies involving human participants were reviewed and
19 have been formulated and implemented quite quickly, the approved by Research Ethics Committee for the Faculty of
present study warns about the importance of studying differences Health Sciences of Trairi of the Federal University of Rio
between urban and rural environments. Different contexts can Grande do Norte under protocol number 2.830.540. The
generate different responses to the current state of the world patients/participants provided their written informed consent to
pandemic, reflecting the need for differentiated strategies in participate in this study.
health care for the population.
In conclusion, our findings suggest that the pandemic may
have had a positive impact on the anxiety and eating behavior AUTHOR CONTRIBUTIONS
of the participants, which may be due to the differences
between urban and city dwellers and living with families. These FF, AM, and FL conceived and designed the study, conducted
findings demonstrate the importance of discussing the effects the statistical analysis, and wrote and revised the manuscript. FF
of the current environment on the regulation of cognitive and organized the database. All the authors contributed to the article
dietary adaptations, as well as emphasizing the importance of and approved the version submitted.
diversifying participants, since contexts in which we live are
essential to understanding possible variations in the behavioral
expression of our species. FUNDING
This work was supported by the Coordenação de
DATA AVAILABILITY STATEMENT Aperfeiçoamento de Pessoal de Nível Superior (CAPES—Grant
number 001) and Conselho Nacional de Desenvolvimento
The raw data supporting the conclusions of this article will be Científico e Tecnológico (CNPq—Grant Number
made available by the authors, without undue reservation. 310515/2018-1).
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